When the frequency of attacks are causing significant educational / social constraints AND that all involved want to consider surgery.Post traumatic where the patient has decided they want surgical management.Persisting unilateral epistaxis, particularly in teenage males.Once failed adequate medical management.Unilateral epistaxis or unilateral obstruction.Unilateral sinus opacification because of risk of malignancy.Complicated sinus disease (extrasinus extension, suggestion of fungal disease).involving sphenoid, ethmoid or frontal sinus)

Failed adequate medical management with CT evidence of sinus disease beyond the maxillary sinuses (e.g.

Structural abnormality within the vestibular system on CT/MRI.

Failure to settle with topical medication.Discharging ear for longer than 3 months.When vertigo exists with acute perforation.Traumatic perforation not healing after 3 months.Child diagnosed with a syndrome à Refer directly to Sydney Children’s Hospital Network.Audiological evidence of effusion with history suggestive of social/classroom impairment in school aged children.Audiological evidence of bilateral effusion with history suggestive of developmental delay in infant.Persistent audiological evidence of effusion longer than 3 months.Child with craniofacial abnormality à Refer directly to Sydney Children’s Hospital Network.Recurrent ear infections with associated otorrhoea.More than 3 Recurrent ear infections with resulting social/developmental concerns within 12 months.

Barotrauma ear infant